Prior Authorization for Power Mobility Devices Expanded

(HealthDay News) — Prior authorization for power mobility devices will be expanded to additional states and will also be tested in additional services, according to the Centers for Medicare & Medicaid Services (CMS).

Noting that prior authorization supports efforts to safeguard beneficiaries’ access to medically necessary items and services while reducing inappropriate Medicare billing and payments, the CMS announced plans to expand its scope.

Based on claims data from September 2013, monthly expenditures for certain power mobility devices decreased across the seven demonstration states, from $12 million in September 2012 to $4 million in August 2013. No reduction was seen in beneficiary access to medically necessary items. The number of states involved in this demonstration will be expanded from seven to 19. In addition, the prior authorization process will be expanded to include certain durable medical equipment, prosthetics, orthotics, and supplies — items that are often used unnecessarily. Public comment will be solicited on this prior authorization process through a proposed rule, as well as on criteria for establishing a list of durable medical items that are often used unnecessarily and may be subject to the new prior authorization process.

“With prior authorization, Medicare beneficiaries will have greater confidence that their medical items and services are covered before services and supplies are rendered. This will improve access to services and quality of care,” CMS Administrator Marilyn Tavenner said in a statement.

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